Antibiotics Flashcards
administering CISPLATIN to ovarian cancer pt. before administrating infusion you should take which of the following actions
1. infuse 1-2L of IV fluid
2. check clients peripheral pulses
3. administer an anti-emetic
4. evaluate clients hearing
5. determine clients weight
1,3,4,5
Treating a pt who is taking 5-FU for breast cancer. What should you monitor for?
A. Nepfrotoxicity
B. Inflammation of the mouth & skin
C. Hepatoxicity
D. Inflammation of the airway
B
Bacteria is a single cell organism, can be ____ or ____ shaped
cocci, rod
Which gram bacteria is easy to target ?
two layer cell wall
Gram POSITIVE
Which gram bacteria is difficult to treat?
3 layer cell wall
Gram NEGATIVE
Gram Positive Cocci infects what sites?
8 general sites of infection
- skin
- soft tissue
- heart
- lung
- bone
- joints
- hardware
- inwelling lines
What sites do Gram Negative Rods infect ?
3 general sites of infection
- lung (HCAP, HAP, VAP)
- any intraabdominal organ
- gentitourinary system
Anaerobes infect what sites?
3 general sites of infection
- Lungs (abscess)
- Oral cavity
- any intraabdominal organ
What sites do Atypicals infect?
1 general site of infection
Lung (CAP)
BACTERICIDALS act by ___ and involve inhibitors of ____, ____ & ____, & _____
- targeting surviving bacteria
- inhibitors of cell wall synthesis,
- DNA synthesis & integrity
- aminoglycosides (AMG)
Bactericidals that are inhibitors of cell wall synthesis
5 meds
- Penicillin
- cephalosporins
- aztreonam
- carbapenems
- vancomycin
Bactericidals that are inhibitors of DNA synthesis & integrity
2 meds
- fluoroquinolones
- metronidazole
BACTERIOSTATIC act on____
targets necessary for bacterial growth but NOT survival
Inhibitors of protein synthesis
(bacteriostatic)
4 meds
- AMG
- Macrolides
- Clindamycin
- Tetracyclines
Bacteriostatic involves ____, _____, ___
3
- sulfonamides
- trimethoprim
- chloramphenicol
bateriostatics may be …..
bactericidal at higher concetration but toxicity
Penicillin is an antibiotic that can treat …
gram + & -
Penicillin prototype drugs include
4 meds
- Amoxicillin
- Penicillin G
- Nafcillin
- Piperacillin
T/F: penicillin be given to pregnant patients
True
Penicillin MOA
destroy cell wall
Penicillin SE:
N/V/D
Penicillin ADRs
- C.Diff
- Candida Albicia (thrush)
- Penicillin Rash
- SJS
- Toxic Epidermal Necrolysis
Penicillin CONSIDERATIONS
- DONT crush pill
- oral pills take w/ food
- can reduce the effects of contraceptives
- Monitor for skin rash’s
How is penicillin allergy determined ?
only by a patients skin test
Extra info:
* ~98% truned out not allergic
* >85% of 276 physicians reported never consulting allergist or immunologist for antibiotic allergies or skin test
* >40% not aware that penicillin rash can resolve over time
Penicillin allergy sings & alternative use
hives, laryngeal edema, difficulty breathing
use alternative antibiotics;Aztreonam, or broad spectrum (less effective cost & more SE)
Why is AMOXICILLIN given with CLAVULANIC ACID? (augmentin)
to inhibit bacteria beta lactamase which willl prevent amoxicillin to destroy other enzymes
Does CLAVULANIC ACID help destroy pseudomonas?
NO, its least reactive to pseudomonas
If pt has an allergy to PCN dont give ____ consider giving ____
DONT give CEPHALOSPORIN
CONSIDER giving **AZTREONAM **
What should you always check/ask before administration
not the patient rights but ask for ….
what the ALLERGIES is
Whats a SUPER INFECTION?
Overuse of antibiotics tied to rise in serious infections such as C.Diff or pseudomembranous colitis
What meds can cause Superinfection ?
6
- Clindamycin
- Amoxicillin
- Ampicillin
- Cephalosporins Penicillin
- Erythromycin
- Quinolones
CEPHALOSPORINS are similar to ____ and are ___
PCN (like sisters)
A beta lactam, stronger med as it can cover more gram+ & - bacteria
MRSA can be treated with ____
Ceftaroline
Cephalosporins SE
N/V/D
Cephalosporins ADRs:
what to monitor & avoid
Monitor for C.Diff
If given IV must be diluted & monitor BUN & Creatine
NO Alcohol!!! (can cause disulfiram-like reaction)
What s a disulfiram-like reaction?
N/V, flushing, dizziness, HA, abdominal discomfort
general hungover symptoms
What should you monitor if taking Cefotetan? (cephalosporin)
Must monitor prothrombin time, INR & PTT
Monobactam: **Azactam ** MOA
weaken & destroy cell wall
Azactam SE (2) & monitor for (2)
- pain , thromnophlebitis & inflammation at IV site
- watch for C.Diff & Anaphylaxis
Carbapenems: IMIPENEM, MEROPENEM
MOA
-penem
- Beta lactam; destroys cell wall of gram + & - and anerobic bacteria
- Great for GI infections
SE of carbapenems
N/V/D
Carbapenems ADRs:
monitor and avoid
- Watch for C.Diff & Candida Albicia
- decrease rate through IV to avoid ADR
- DONT give if patient has PCN or Ceph ALLERGY
Vancomycin is a ____
bactericidal
Vancomycin is used ONLY for ____, ____, & to treat _____
Gram +
MRSA
& C.Diff
Vancomycin MOA
destroys cell wall by attacking transpeptidase
Vancomycin SE:
N/V/D
Vancomycin ADRs
- Nephrotoxic
- Tachycardia, hypotension, rash pruritis, urticaria, flushing (RED MAN SYNDROME) => STOP infusion
- Ototoxicity (tinnitus)
- IV form infuse over 1 hr
- ALWAYS monitor trough levels (q4-6h)
Tetracycline: DOXYCLINE & MINOCYCLINE
MOA
inhibit protein synthesis which inhibits transfer of RNA
Tetracycline SE
N/V/D
Tetracylcine ADRs
- DONT give to kids under 8; can cause bone suppression & teeth staining
- Hepatotoxicity
- watch for C.Diff & Candida
- Photosensitive
Considerations for Tetracycline
DONT give to PREGNANT pts.
Interventions for Tetracyclines
6 total
- take w/ non dairy food (med interacts w/ calcium)
- ensure pt is NOT pregnant
- Monitor LIVER functions
- Best if given 1-2 hrs post eating
- DONT take w/ Antacid (d/t calcium)
- will reduce effectiveness of contraceptives
Macrolides: ERYTHROMYCIN & AZITHROMYCIN
MOA
inhibit protein synthesis
Macrolides SE
N/V/D, HA, dizziness
Macrolides ADRs
- monitor for ventricular dysrhythmias (rare); prolonged QT intervals
- Ototoxicity
- watch for C.Diff & Candida
Interventions for Macrolides
- Monitor LIVER & KIDNEY functions
- Long-term use: Monitor EKG for QT prolongation
- Macrolides utilize CPY3A enzymes, therefore monitor pt. closely who are taking CCB, HIV meds*
- will increase digoxin, warfarin, & theophylline levels
Aminoglycosides: GENTAMICIN, TOBRAMYCIN, NEOMYCIN, STREPTOMYCIN
MOA
inhibit protein synthesis
Aminoglycosides treats ___
gram NEGATIVE bacilli
Aminoglycosides ADRs
Ototoxicity & Nephrotoxicity
Aminoglycosides overall Interventions
monitor for tinnitus, HA or vertigo (ototoxicity)
Monitor BUN, Creatine & Urine Output
Drink plenty of water
DONT give with PCN or CPH or Vancomycin
Interventions for giving Tobramycin IV
Monitor urine output
Closely monitor creatine & BUN
Streptomycin can be given for ____. ADRs include…
TB
deafness (ototoxicity) & decrease urine output (nephrotoxicity)
Fluoroquinolones: CIPROGLOXACIN & MOXIGLOXACIN
MOA
inhibits the 2 enzymes necessary for cell division, DNA gyrase & topisomerase
Fluoroquinolones treats…..
anthrax, aerobic, gram - & +, & anerobic bacteria
Fluroquinoles SE
N/V/D/ HA, dizziness
Fluroquinoles ADRs
DIRTY MED
- dizziness, HA, confusion (in older adults)
- QT prolongations
- rupture of achilles tension
- Avoid Cipro w/ kids d/t damages cartilage (generally avoid all fluro with kids)
- Photosensitivity
- Seizure, Increase ICP
- C.Diff & Candida
- SI
- Hepatoxicity
Fluroquinoles Interventions
- Monitor for CNS symptoms
- d/c med if any symptoms occur
- teach to wear extra layer while outside (will get sunburned)
- AVOID caffeine while taking med
- take TUMS, supplement dairy products 2 hrs after or 6 hrs before taking Cipro
Sulfonamides: SULFAMETHOXAZOLE/TRIMETHROPRIM
MOA
inhibits folic acid synthesis
Sulfonamides systemic use causes what
ADR
Sulfonamides SE
N/V/D
Sulfonamides ADR:
- SJS (fatal skin disorder causing agranulocytosis, anemia, & thrombocytopenia)
- C.Diff & Candida
- Nephrotoxic
- DONT give to infants or pregnant pts
Sulfonamides interventions
- Take w/ food
- Monitor for CBC for changes in erythrocytes, leukocytes or platelets
- DONT give w/ pts who have megablastic anemia
- Monitor KIDNEY & LIVER functions
- Reduce the effect of oral contraceptives
- TEACH about adequate hydration it can prevent ADR
Methenamine is a _med that treats __.
- Urinary Tract Anti-septic med
- treats gram + & -, concentrated in the urine
Methenamine, Nitrofurantoin
MOA
interfere w/ RNA & DNA producing enzyme
Methenamine SE
N/V/D
Methenamine ADRs
- pulmonary distress (dyspnea, chest pain, chills) => lead to pulmonary damage
- peripheral neuropathy
- blood cell deficiencies (monitor CBC)
- can cause stains on teeth
Methenamine interventions
- monitor respiratory symptoms
- monitor signs of neuropathy ( especially w/ ppl w/ kidney damage)
- take w/ food or fluids
- brush teeth frequently to avoid staining
- DONT give to pregnant pt or infants
Nursing considerations for ALL Anti-biotics
- Always educate pt on how to take med
- Monitor for ADR, SUPER INFECTIONS; C.Diff, Candida
- Monitor lab work
- DONT DRINK w/ ALCOHOL
- Always watch for repiratory status w/ all med. can be anaphylaxis
